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Management of spinal-induced hypotension for elective caesarean section: A survey of practices among anesthesiologists from a developing country
Get PDFBackground: In developing countries, more than half of the
anesthesia-related maternal deaths are related to spinal hypotension.
Objective: To explore the practices of management of spinal induced
hypotension with respect to fluid and vasopressor administration among
anesthesiologists from a developing country. Methods: After approval
from institutional ethics committee, an online questionnaire was sent
to anesthesiologists registered with Pakistan Society of
Anesthesiologists between July and August 2018 to determine management
strategies for prevention and treatment of spinal-induced hypotension.
Results: The response rate was 36% (156/433), majority from academic
institution (62.8%) with equal representation from attending and
trainee anesthesiologist. For prophylaxis 39.1% respondents did not use
vasopressors, 32.7% used fluid preloading with crystalloids (54.7%) as
fluid of choice followed by combination of co-loading and
vasopressor(22.4%). Phenylephrine was the vasopressor of choice for
both prophylaxis (33.1%) and treatment (57%). Attending
anesthesiologist used a combination of fluid co-loading and
vasopressors for prophylaxis as compared to trainee anesthesiologists
(37.2% vs. 17.9%; P=0.035) and selected vasopressors according to
patient\u2019s heart rate (33.3% vs. 19.5%; p=0.05). Prophylactic
phenylephrine was used more by respondents from the academic
institution (p=0.023). Fluid co-loading was used more by respondents
with <30 % compared to those with > 30% of clinical
responsibility to obstetric anesthesia (P<0.05). Conclusion:
Phenylephrine as the vasopressor of choice indicates growing awareness
of management strategies among anesthesiologists from developing
countries but there is a need to increase its use for prophylaxis. Some
variation in practice according to the level of anesthesiologist,
practice type and responsibilities to obstetric anesthesia are evident
Pediatric self-medication use in Rwanda \u2013 a cross sectional study
No full textBackground: Self-medication, a worldwide practice, has both benefits
and risks. Many countries have regulated non-prescription medications
available for use in self-medication. However, in countries such as
Rwanda, where prescriptions are not required to purchase medications,
prescription, non-prescription and traditional medications have been
used for self-medication. Objectives: To determine the reported
self-medication use in Rwanda and to determine attitudes and reasons
associated with parental decisions to self-medicate their children.
Methods: A cross-sectional multi-center questionnaire based
quantitative study of 154 parents/caregivers of children under ten
years undertaken in private and public health facilities. Results: The
use of self-medication was reported to be 77.9%. Among these
parents/caregivers, 50.8% used modern self-medication only, 15.8% used
traditional self-medication only and 33.3% used both types of
self-medication. Paracetamol was the most commonly used drug in modern
self-medication; the traditional drugs used were Rwandan local herbs.
Parents/caregivers who used modern medicines had slightly more
confidence in self-medication than self-medication users of traditional
medicines (p=0.005). Parents/caregivers who used modern self-medication
reported barriers to consultation as a reason to self-medicate more
frequently than those who used traditional drugs. Having more than one
child below 10 years of-age was the only socio-demographic factor
associated with having used self-medication (AOR=4.74, CI: 1.94-11.58,
p=0.001). Being above 30 years (AOR= 5.78, CI: 1.25-26.68, p=0.025) and
living in Kigali (AOR=8.2, CI: 1.58-43.12, p=.0.012) were factors
associated with preference of modern self- medication compared to
traditional self-medication. Conclusion: Self-medication is common in
Rwanda. Parents/caregivers are involved in this practice regardless of
their socio-demographic background
Histopathologic spectrum of childhood tumours in a Tertiary Hospital: a ten-year review
Get PDFBackground: There has been a growing public health burden of childhood
tumours in low and middle income countries (LMICs) as the trend in
epidemiological transition continues to vary. Objective: The objective
of this report is to determine the spectrum of childhood tumours at a
tertiary hospital in Nigeria. Methods: A retrospective review of the
histopathology register over the period January 2006 to December 2015.
Results: The total paediatric tumour cases was 248, including 143
(57.7%) females and 105 (42.3%) males, aged 0 \u2013 12 years (mean
6.1years \ub1 3.97 SD). The age group 2 - 5 year cohort had the
highest prevalence of tumour. The predominant tumour based on tissue of
origin was epithelial neoplasms 88 (35.5%), vascular neoplasms 56
(22.6%), neural neoplasm 42 (16.9%), mesenchymal neoplasm 37 (14.9%),
germ cell neoplasm 13 (5.2%) and haematopoietic neoplasms 12 (4.8%).
Majority of the tumours were benign, 148 (59.7%) and malignant 100
(40.3%). The most predominant benign tumour was haemangioma 33 (13.3%)
and predominant malignant tumour was lymphoma 22 (8.9%). Conclusion:
Benign tumours remain the commonest neoplasm of children in this
hospital-based data. Development and implementation of a tumour
registry would provide a more comprehensive information
Comparison of heart rate response and heart rate recovery after step test among smoker and non-smoker athletes
Get PDFBackground: Exercise performance depend on the ability of the
cardiovascular system to respond to a wide range of metabolic demands
and physical exertion. Objectives: To investigate the habitual smoking
effects in heart rate response and heart rate recovery after step test
in athletes. Methods: Seventy-eight physically healthy active athletes
(45 non-smokers and 33 smokers) aging 27\ub18years old, participated
in this study. All participants completed the International Physical
Activity Questionnaire and performed the six-minute step test.
Cardiovascular parameters such (resting heart rate, peak heart rate,
heart rate at 1 min after testing, heart rate recovery, recovery time,
blood pressure at rest, and post-testing blood pressure) were recorded.
Results: Smoker-athletes had higher resting heart rate (76 \ub1 9bpm
vs. 72 \ub1 10bpm, p<0.05), maximum heart rate (154 \ub1 18bpm
vs. 147 \ub1 17bpm, p<0.05) and recovery time (7min 25sec \ub1
6min 31sec vs. 4min 21sec \ub1 4min 30sec, p<0.05) than non-smoker
athletes. Scores from the IPAQ were approximately the same (\u39c=7927
\ub1 10303, \u39c= 6380 \ub1 4539, p<0.05). Conclusion: Smoking
was found to affect athletes' cardiovascular fitness. The change of the
athletes\u2019 heart rate recovery and recovery time contributes to
the adaptation of cardiovascular function in training requirements
Corona viruses: reaching far beyond the common cold
Get PDFBackground: Human coronaviruses (HCoVs) are one of the most common
causes of the \u201ccommon cold\u201d. Some HCoV strains, however,
can cause fatal respiratory disease. Some examples of these diseases
are severe acute respiratory syndrome (SARS), Middle East respiratory
syndrome (MERS), and Coronavirus Disease 19 (COVID-19). This article
will review the etiology, clinical features, diagnosis, and management
of HCoVs. Methods: A systematic literature review was performed using
the terms \u201chuman coronaviruses\u201d, \u201cMERS-CoV\u201d,
\u201cSARSCoV\u201d, \u201cSARS-CoV2\u201d, \u201cCOVID-19\u201d,
and \u201ccommon cold\u201d in OVID MEDLINE, PubMed, and Cochrane
Library. Findings: Most HCoVs cause mild upper respiratory infections
which resolve with supportive care and no sequelae. In recent decades,
however, there have been outbreaks of novel HCoVs that cause more
severe disease. This is largely due to HCoVs having large genomes which
undergo frequent recombination events, leading to the emergence of
novel and more virulent strains of the virus. These severe respiratory
illnesses can lead to acute respiratory distress requiring invasive
intervention, such as mechanical ventilation. These severe infections
can lead to long-lasting sequelae in patients. Scientists continue to
investigate potential treatments for these viruses, though supportive
care remains the gold standard. Scientists have succeeded in developing
numerous vaccines for the SARS-CoV-2 virus, and ongoing data collection
and analysis will shed even more light on the next steps in fighting
the COVID-19 pandemic. Conclusion: Due to the frequency of
recombination events and the subsequent emergence of novel strains,
HCoVs are becoming more prevalent, making them a global health concern
as they can lead to epidemics and pandemics. Understanding the
epidemiology, etiology, clinical features, diagnosis, and management of
HCoVs is important, especially during this worldwide pandemic
Bacterial vaginosis, the leading cause of genital discharge among women presenting with vaginal infection in Dar es Salaam, Tanzania
Get PDFBackground: Pathological vaginal discharge is a common complaint of
women in reproductive age worldwide caused by various agents. The
prevalence and etiologic agents vary depending on the population
studied. Management of vaginal discharge in low-income countries,
typically depend on the syndromic approach, which limits understanding
the specific causative agents. We determined the proportion of
bacterial vaginosis, candidiasis, and trichomoniasis among women with
vaginal discharge at a regional referral hospital in Dar es Salaam,
Tanzania. Methods: We conducted a cross-sectional study between June
and August of 2017 among nonpregnant women at Amana Regional Referral
Hospital. Experienced staff performed physical examination to establish
a clinical diagnosis, and collection of the high vaginal swab for
microscopic examination. Descriptive statistics were performed to
assess the characteristics of study participants and the proportion of
vaginal infections. Results: A total of 196 samples were collected, of
all, 128 (65.3%) had either bacterial vaginosis, candidiasis, or
trichomoniasis. Bacterial vaginosis was the leading infection at 33.2%,
followed by candidiasis (19.4%) and trichomoniasis (13.3%). Laboratory
confirmed vaginal infection were generally found more in age below 25,
unmarried, and those employed or petty business. Conclusion: The
proportion of bacterial vaginosis in women with vaginal discharge was
relatively higher than others, and the presence of vaginal infection
relate to span style="font-family:'Times New
Roman'">socio-demographic characteristics. Further advanced studies
are needed to understand the potential role of aetiologic agents in
causing vaginal infections
Evaluation of clinical, etiological and antimicrobial resistance profile of pediatric urinary tract infections in a secondary health care centre
Get PDFBackground: Urinary tract infections are common during childhood. The
etiologic agents and empirical antibiotics may vary due to age and
geographic area. Objectives: This study was designed to investigate the
urinary tract infection pathogens, their antibiotic resistance profile
and risk factors in a sample of well-child population. Materials and
Methods: This retrospective study was conducted in the pediatric
clinics of a secondary health-care centre in a one-year period. The
source of data was hospital and laboratory records. Toilet trained
children and adolescents aged between 5-17 years old with positive
urine culture were enrolled into the study. Microbiological studies
were conducted according to international guidelines. Results: During
the study 3640 urine samples were analyzed and 342(9.4%) had
significant growth. Gram negative enterobacteria were the most common
infectious agents. Antibiotic susceptibility tests showed low
cephalosporine resistance unless ESBL was positive. Multi drug
resistance was remarkable. Extended beta lactamase resistance rate was
17%. Previous history of antibiotic use before the present
administration was the only significant risk factor for ESBL
positivity. Conclusion: Treating urinary tract infections may become an
emerging problem soon. Unless there are risk factors, cephalosporines
are good options, but if so nitrofurantoin or carbapanems should be
preferred for treatment in this population
Early detection of Pre-XDR TB with line probe assay in a high TB burden country
Get PDFBackground - Worldwide, tuberculosis (TB) is one of the top 10 causes
of death. Drug resistant tuberculosis has lately become a major public
health problem that threatens progress made in Tuberculosis (TB) care
and control worldwide. The aim of this study was to determine the
prevalence of Pre-extensive drug resistant TB among MDR TB in North
Central of Nigeria. Methods - This study was conducted from October,
2018 to August, 2019 with 150 samples. In Nigeria, guidelines for DR-TB
as recommended by WHO is followed. All the samples from the patients
who gave their consent were transported to a zonal reference TB
laboratory (ZRL). Results - Mean age was 38.6 \ub1 13.4 years with
peak age at 35-44. Out of these 103 samples processed with LPA,
101(98%) were rifampicin resistant and 2 were rifampicin sensitive,
99(96%) were INH resistant and 4 (4%) were INH sensitive, 5(5%) were
fluoroquinolone resistant, 98(95%) were fluoroquinolone sensitive, 12
(12%) were Aminoglycoside + Capreomycin resistant, 91(83%) were
Aminoglycoside + Capreomycin sensitive. Conclusion - Multidrug
resistant TB and its severe forms (Pre-extensive & extensively drug
resistant TB) can be detected early with rapid tool- Line Probe Assay
rapid and prevented timely by early initiation on treatment
Increased ambulatory arterial stiffness index and blood pressure load in normotensive obese patients
No full textObjectives: It has been shown that blood pressure (BP) values measured
in obese subjects are higher than the individuals with normal weight,
even in normotensive limits. However, data concerning the Ambulatory
Arterial Stiffness Index (AASI) and blood pressure load in normotensive
obese subjects is lacking. This study was aimed to compare the
ambulatory arterial stiffness index and blood pressure load in
normotensive obese and healthy controls. Methods: One hundred
normotensive obese and one hundred normal weight subjects were included
in this study. All subjects underwent 24-hour ambulatory blood pressure
monitoring. Ambulatory arterial stiffness index was calculated from
24-hour ambulatory blood pressure monitoring records. Ambulatory
arterial stiffness index was defined as one minus the regression slope
of unedited 24-h diastolic on systolic blood pressures. Systolic blood
pressure (SBP) and diastolic blood pressure (DBP) load values were
calculated from 24-hour ambulatory blood pressure monitoring analysis.
Results: Ambulatory arterial stiffness index of the obese subjects was
significantly higher than the healthy controls (0.48\ub10.2 vs.
0.33\ub10.11, p<0.001). 24-hours systolic blood pressure and
diastolic blood pressure loads were significantly higher in obese
subjects. Logistic regression analysis revealed that body mass index
(BMI) was an independent predictor for an abnormal ambulatory arterial
stiffness \u131ndex ( 650.50) (OR: 1.137, 95% CI: 0.915-1.001,
p=0.004). Conclusion: Blood pressure load and ambulatory arterial
stiffness index are increased in normotensive obese patients. Moreover,
body mass index is an independent predictor for an abnormal ambulatory
arterial stiffness index. Our results indicate that obese subjects are
at higher risk for future cardiovascular events despite normal office
BP levels